Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States
Authors: Kaja Z. LeWinn, Leonardo Trasande, Andrew Law, Courtney K. Blackwell, Traci A. Bekelman, Jessica A. Arizaga, Alexis A. Sullivan, Theresa M. Bastain, Carrie V. Breton, Margaret R. Karagas, Amy J. Elliott, Catherine J. Karr, Kecia N. Carroll, Anne L. Dunlop, Lisa A. Croen, Amy E. Margolis, Akram N. Alshawabkeh, Jose F. Cordero, Anne Marie Singh, Christine M. Seroogy, Daniel J. Jackson, Robert A. Wood, Tina V. Hartert, Young Shin Kim, Cristiane S. Duarte, Julie B. Schweitzer, Barry M. Lester, Cynthia T. McEvoy, Thomas G. O’Connor, Emily Oken, Nicole Bornkamp, Eric D. Brown, Christina A. Porucznik, Assiamira Ferrara, Carlos A. Camargo, Qi Zhao, Jody M. Ganiban, Lisa P. Jacobson, P B Smith, K L Newby, Lisa P Jacobson, C B Parker, Richard C Gershon, David Cella, Susan L Teitelbaum, Annemarie Stroustrup, Andrea L Lampland, Mark L Hudak, Lisa K Washburn, Glorisa J Canino, Steven L Pastyrnak, Charles Neal, Brian S Carter, Jennifer B Helderman, Hyagriv Simhan, Jean Kerver, Charles Barone, Nigel Paneth, Michael R Elliott, Susan L Schantz, Robert M Silver, Rosalind J Wright, Michelle Bosquet-Enlow, Alex Mason, Frances Tylavsky, Qi Zhao, Sheela Sathyanarayana, Chris Fussman, Shohreh F Farzan, Rima Habre, Robert S Tepper, James Gern, Rachel L Miller, Ruby HN Nguyen, Judy L Aschner, Stephanie L Merhar, Paul E Moore, Gloria S Pryhuber, Lynne M Smith, Emily S Barrett, Anne Marie Reynolds, Lisa Gatzke-Kopp, Margaret M Swingler, Jonathan M Mansbach, Jonathan M Spergel, Edward M Zoratti, Casper G Bendixsen, Leonard B Bacharier, George T O’Connor, Meyer Kattan, Katherine Rivera-Spoljaric, Christine C Johnson, Irva Hertz-Picciotto, Daphne Koinis Mitchell, Viren D’Sa, Dana Dabelea, Sean CL Deoni, Alison E Hipwell, Leslie D Leve, Scott T Weiss, Kristen Lyall, Heather Volk, Stephen R Dager, Robert T Schultz, Rawad Obeid, Caitlin Rollins, Michael E Msall, Michael O'Shea, Ruben Vaidya, John Meeker, Federico Laham, Susan Wu, Juan C Celedón, Henry T Puls, Stephen J Teach, Stephen C Porter, Ilana Y Waynik, Sujit Iyer, Margaret E Samuels-Kalow, Amy D Thompson, Michelle D Stevenson, Cindy S Bauer, Nancy R Inhofe, Markus Boos, Charles G Macias, Catherine Monk, Jonathan Posner, Gurjit Hershey, Kathryn Keenan, Jenae Neiderhiser, Augusto Litonjua, Robert Zeiger, Leonard Bacharier, Rebecca Landa, Sally Ozonoff, Rebecca Schmidt, Joseph Piven, Kelly Bear, Madeleine Lenski, Rachana Singh, Jean A Frazier, Semsa Gogcu, Angela Montgomery, Karl C Kuban, Laurie M Douglass, Hernan Jara, Robert Joseph, Douglas Ruden, Julie Herbstman, Tracey Woodruff, Angelo P Giardino, Joseph Stanford, Mark Innocenti, Elizabeth Conradt, Kathi Huddleston, Shanna Swan
Journal: JAMA Network Open (2023)

Importance Few population-based studies in the US collected individual-level data from families during the COVID-19 pandemic. Objective To examine differences in COVID-19 pandemic–related experiences in a large sociodemographically diverse sample of children and caregivers. Design, Setting, and Participants The Environmental influences on Child Health Outcomes (ECHO) multi-cohort consortium is an ongoing study that brings together 64 individual cohorts with participants (24 757 children and 31 700 caregivers in this study) in all 50 US states and Puerto Rico. Participants who completed the ECHO COVID-19 survey between April 2020 and March 2022 were included in this cross-sectional analysis. Data were analyzed from July 2021 to September 2022. Main Outcomes and Measures Exposures of interest were caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural (population &amp;amp;lt;50 000) residence. Dependent variables included COVID-19 infection status and testing; disruptions to school, child care, and health care; financial hardships; and remote work. Outcomes were examined separately in logistic regression models mutually adjusted for exposures of interest and race, ethnicity, US Census division, sex, and survey administration date. Results Analyses included 14 646 children (mean [SD] age, 7.1 [4.4] years; 7120 [49%] female) and 13 644 caregivers (mean [SD] age, 37.6 [7.2] years; 13 381 [98%] female). Caregivers were racially (3% Asian; 16% Black; 12% multiple race; 63% White) and ethnically (19% Hispanic) diverse and comparable with the US population. Less than high school education (vs master’s degree or more) was associated with more challenges accessing COVID-19 tests (adjusted odds ratio [aOR], 1.88; 95% CI, 1.06-1.58), lower odds of working remotely (aOR, 0.04; 95% CI, 0.03-0.07), and more food access concerns (aOR, 4.14; 95% CI, 3.20-5.36). Compared with other age groups, young children (age 1 to 5 years) were least likely to receive support from schools during school closures, and their caregivers were most likely to have challenges arranging childcare and concerns about work impacts. Rural caregivers were less likely to rank health concerns (aOR, 0.77; 95% CI, 0.69-0.86) and social distancing (aOR, 0.82; 95% CI, 0.73-0.91) as top stressors compared with urban caregivers. Conclusions Findings in this cohort study of US families highlighted pandemic-related burdens faced by families with lower socioeconomic status and young children. Populations more vulnerable to public health crises should be prioritized in recovery efforts and future planning.